JP2022528930A - Steering device with removable parts - Google Patents

Abstract

The steering device for connecting to the long instrument is a locking plate with a joint that can fix the steering plate of the long instrument so that the steering plate and the locking plate move together, and a steering unit for moving the locking plate. And prepare. The length instrument extends along the instrument shaft and comprises multiple length elements secured to the steering plate at the proximal end of the instrument shaft, the steering plate around the support member fixed to the instrument shaft. Connected to be movable. [Selection diagram] FIG. 3B

Description

[0001] The present invention relates to steerable instruments for invasive and non-invasive type applications such as surgery. Such instruments can be used, for example, in the fields of gastroscopy, colonoscopy, endoscopy, laparoscopy, and other medical applications. However, the steerable device according to the present invention can also be used for non-medical applications. Examples of the latter include inspection and / or repair of mechanical and / or electronic hardware in hard-to-reach places.

[0002] Converting a surgical intervention that requires a large incision to expose the target area into a minimally invasive surgical intervention, i.e., a natural opening or a small incision to establish access to the target area. The need for only is a well-known and ongoing process. When performing minimally invasive surgical interventions, surgeons such as physicians require an access device configured to introduce and guide invasive instruments into the body through the access port of the human or animal body. And. To reduce scar tissue formation and pain for human or animal patients, access ports are preferably provided by a single small incision in the skin and underlying tissue. In that respect, the possibility of using the natural meatus of the body would be even better. The access device preferably allows the surgeon to control one or more degrees of freedom provided by the invasive instrument. In this way, the surgeon can perform the required actions in the target area of the human or animal body in an ergonomic and accurate manner.

[0003] Steerable surgical invasive instruments in the fields of gastroscopy, colonoscopy, endoscopy, laparoscopy, etc. are well known in the art. The invasive device can be equipped with a steerable tube-shaped device that enhances its navigation and steering capabilities. Such a steerable tube-shaped device may include a proximal end portion, a distal end portion containing at least one deflectable zone, and a rigid or flexible intermediate portion or shaft that is steerable. The tube-shaped device further comprises a steering configuration adapted at its proximal end to deflect the distal deflectable zone with respect to the central axis of the tube-shaped device.

[0004] Most known instruments are complex to manufacture and result in expensive instruments. Often, the distal end of the instrument comprises a flexible zone consisting of a hinge pin, a coil, or a separate link to the flexible plastic extruded article. Steering cables should be guided through holes through these links and / or through guide eyes or hooks.

[0005] In many prior art devices, the steering configuration comprises a conventional steering cable as a control member, eg, having a diameter of less than 1 mm, where the steering cable is associated with a deflection at the distal end portion of the tubular device. Placed between the possible zone and the steering configuration at the proximal end. Alternatively, in any embodiment shown or described herein, the control member may be implemented, for example, by one or more sets of length elements formed by laser cutting in a tube element. Further details regarding the design and manufacture of the steerable tubes described above and their steering configurations are described, for example, in WO2009 / 112060A1, WO2009 / 127236A1, WO2017 / 213491A1, and WO2018 / 067004. Such instruments can be advantageously used in endoscopic surgery where the length does not need to exceed, for example, 1 meter. In another embodiment, more specifically, an instrument that exceeds 1 meter, for example 1 to 2 meters, can be made. They can be constructed by cutting tube elements and / or using elongated elements formed by cables or wires.

[0006] In some cases, plastic extruded tubing can be used with an integrated channel for accommodating cables. This simplifies the structure of the instrument. However, most plastics are fairly weak. For very long instruments, eg instruments longer than 1 meter, the problem is due to the large force applied to both the steering cable and the actuation cable, which are configured to operate the tool at the distal end of the instrument. Can occur. Problems can be unwanted cuts, slip stick effects in plastic tubes, and often too high friction on the cable, making steering with the steering cable difficult and difficult to manage. Moreover, the mechanical properties of many plastics are necessary in order to be able to rotate the instrument during use if it may have been guided through some bends that impede the rotation of the entire instrument. It may be too poor to guarantee a sufficiently high torsional rigidity. Another drawback of plastic tubing is that if a working cable is provided at the distal end of the instrument to operate the tool, the force in the working cable is the maximum longitudinal force allowed in the extruded plastic tubing. It is possible that it can increase to the extent that it exceeds. If so, it would be impossible to operate the tool with acceptable force. Moreover, if the plastic tube is in a curved arrangement and a large force is applied to the working cable, the channel for the steering cable can be deformed, especially in the bending / deflection section, so the steering cable is clamped and in the channel. It can no longer move freely at, which hinders proper steering operation in the distal deflectable zone.

[0007] Steering, flexibility, stiffness, and accuracy requirements for medical applications where longer instruments are required, such as colonoscopy, where 1.5 meter long (or longer) instruments can be applied. Is significantly increased. Such have better performance than prior art devices in terms of steerability, longitudinal stiffness, torsional stiffness, durability, and applicability of mechanically actuated tools at the distal end even under end effector activation. It is desirable to develop an instrument.

[0008] In medical applications, contamination of the instrument after it has been used to perform a surgical procedure on a patient can be a problem leading to unwanted postoperative complications. Contamination can result from blood, other body fluids, tissues, etc. As a result of contamination, the device may contain bacteria, viruses, or other biological or chemical substances that may threaten the health of the next patient in which the device is used.

[0009] One method of avoiding this contamination requires thorough cleaning and sterility of the instrument prior to each use. In many cases, the cleaning process is not able to remove all contaminants and / or is very expensive. Therefore, there is still a risk of adverse effects on patients treated with such devices. To prevent the risk of contamination, it is preferable to use disposable instruments that are used only once and are discarded after treating a single patient.

[0010] According to the first aspect of the present invention, the steering device for connecting to the long instrument has a joint capable of fixing the steering plate of the long instrument so that the steering plate and the locking plate move together. It is provided with a locking plate to be held and a steering unit for moving the locking plate. The length instrument extends along the instrument shaft and comprises multiple length elements secured to the steering plate at the proximal end of the instrument shaft, the steering plate around the support member fixed to the instrument shaft. Connected to be movable.

[0011] Such steering devices can allow easy connection and separation of instruments for medical or other surgery. The length device can use the length element for steering purposes, allowing bending and movement at the distal end in any number of directions controlled by the steering unit. By having a steering plate to which the length element is fixed, the length element is held in tension for proper steering and the steering plate allows for easy connection and disconnection. This allows non-technical personnel to quickly, reliably and easily connect the equipment to the steering unit when needed. With this simple connection, the fixture can be disposable, while the more complex parts of the steering device and steering unit can be reused.

[0012] According to embodiments, the locking plate is a first plate having one or more openings for receiving one or more protrusions from the steering plate and one in the one or more openings. It is provided with a second plate capable of fixing the above-mentioned protrusion. Optionally, the second plate has one or more steering plates secured to the locking plate from an open position to allow movement into or out of one or more openings in one or more protrusions. The protrusions rotate from one or more openings to a locked position where they cannot move. Such a connection allows for quick, reliable and easy coupling and separation of the instrument to the steering device. Although the coupling of openings and protrusions is shown and discussed, many other types of rapid and reliable coupling can be used, for example using snaps, clamps, magnets, etc.

[0013] According to embodiments, the steering unit comprises one or more frames connected about one or more axes to allow movement of the steering plate in space. By allowing arbitrary movement of the steering plate, the movement of the instrument can be controlled more precisely.

[0014] According to the embodiment, the locking plate is connected to the steering unit so that the locking plate can rotate with respect to the steering unit. As an option, the locking plate is connected to the steering unit using circumferential ball bearings. Such a connection can allow the instrument to rotate and flex at the distal end.

[0015] According to embodiments, the length element is a flexible cable or wire that extends through the length device to move the distal end of the length device. In other embodiments, the length element can be a rigid cable or wire, thereby allowing push-and-pull movements by the steering device to control the movement of the instrument with great precision.

[0016] According to a further aspect of the invention, a long device for connecting to a steering device includes a long shaft having a distal end and a proximal end, and a steering plate located at the proximal end of the shaft. The steering plate is movably placed around a central support member connected around the shaft, and the steering plate provides a joint for connecting the steering plate to the steering device to control the movement of the steering plate. It comprises a plurality of elongated elements extending along the shaft and secured to the steering plate at the proximal end.

[0017] Such instruments can be used in a variety of medical surgeries, and length elements and steering plates allow flexion and controlled movement of the instrument in any number of directions during surgery. .. The steering plate allows precise control of the degree and direction of bending or movement and can be easily and quickly connected (and disconnected from) to various manual or robotic steering devices. The fixtures are ready for use in simple couplings and then can be discarded after a simple separation and the most complex (and expensive) parts to reuse with new fixtures, such as steering, handles. , Leave the robot part. In some embodiments, removing the fixture from the steering device can allow easier decontamination for reuse instead of disposal.

[0018] According to embodiments, the plurality of elongated elements are circumferentially anchored around the steering plate. This allows bending in any number of directions (depending on the number and placement of the length elements) of the distal end of the instrument, or any part of the instrument shaft to which the length elements are connected.

[0019] According to embodiments, the joint comprises one or more elements for openly connecting to the locking plate of the steering device. Optionally, the one or more elements include one or more extensions that can be openly secured to the locking plate of the steering device. The joint may also be a joint using different forms, eg, a steering plate with an opening and a locking plate with an extension, snaps, clamps, etc., but the instrument is secured to the steering device and when desired. A secure joint must be provided that can be used quickly and easily for separation.

[0020] According to the embodiment, the central support member comprises a ball-shaped element, and the steering plate is connected to the ball-shaped element so that the steering plate can rotate around the ball-shaped element. Such ball-shaped elements can allow the movement required by the steering plate with respect to the instrument shaft, while preventing any movement that can cause kinking or entanglement of the long steering element.

[0021] According to embodiments, a plurality of elongated elements extend through a plurality of openings in the steering plate, and each elongated element is a proximal end for fixing the elongated element to the steering plate. Equipped with fasteners at. Optionally, the plurality of length elements comprises a plurality of flexible wires or cables. Further, as an option, the plurality of flexible wires or cables are tensioned between the position along the long shaft and the position along the steering plate. Such a configuration can ensure that the long elements remain tensioned to the extent required for precise steering control. This is especially important when using flexible cables or wires. Connection and tensioning can be done when the instrument is being manufactured, so only a simple connection to the steering unit needs to be made before using the instrument for surgery. In a further embodiment, the joint can be designed to tension the long element or ensure proper tensioning.

[0022] According to a further aspect of the invention, a method of making a steerable instrument that can be coupled to a steering unit is to form an instrument with a long shaft and a steerable portion, and proximal. Multiple lengths, with a movable connection of the steering plate around the long shaft at the ends, and a joint for connecting the steering plate to the steering device to control the movement of the steering plate. It comprises connecting a measuring instrument to a steerable part and a steering plate. Such a method can produce a steerable instrument that can be quickly and easily connected to or disconnected from a steering device to perform surgery.

[0023] According to embodiments, the step of connecting the plurality of length elements to the steerable portion and the steering plate is to connect the plurality of length elements to a support portion having a plurality of fingers and to connect the plurality of length elements to a support portion having a plurality of fingers. Each of the length elements comprises connecting a plurality of length elements to a steerable portion at a support and a steering plate, which connects to one of a plurality of fingers. The support can be used with multiple fingers to ensure that the long element is supported and in the proper position for easy connection to the steering device. Such a configuration can allow the steering plate to be part of a reusable steering device rather than part of a disposable piece of equipment, with less waste and less waste for the disposable part of the equipment. Brings cost.

[0024] According to a further aspect of the invention, a long device for connecting to a steering device comprises a long shaft having a distal end and a proximal end, and a support at the proximal end of the long shaft. The support extends along a long shaft and is secured to the support at the proximal end, comprising a base and a plurality of fingers extending outwardly outward from the longitudinal axis. It has multiple long elements. Such supports ensure that the length elements of the instrument are properly positioned to connect to the steering device for easy coupling and separation. The support can also ensure that the length element is held in tension for proper storage of the device, and to control the movement of the distal end of the device during use. It can be assured that the element works as intended. The support can be formed from a combination of metal, plastic, or material, depending on the configuration.

[0025] According to the embodiment, the base is connected around the shaft. This can be due to tight coupling, welding, joining, glue, threads, threads, spring elements, or any other means that will secure the base to the shaft. The base can extend only a short distance near the proximal end of the instrument, or in some embodiments, the base can extend to the distal end over the entire length or substantially the entire length of the shaft. The base ensures a stable support with extended fingers to properly position and secure the long element.

[0026] According to embodiments, the base comprises an ulnar canal and the fingers are formed by cutting the ulnar canal into a plurality of longitudinal sections. Optionally, the cut can extend over the entire ulnar canal to transmit bending force at least partially from the proximal end of the instrument to the distal end of the instrument, thereby distal to the instrument. Help steer the edges. The length tube can be an outer tube or can be surrounded by one or more additional tubes and / or protective layers. The use of an ulnar canal that is cut to form a finger provides a simple way to form a support and ensure that the base and finger do not separate. In addition, forming the finger from the tube used for steering ensures that the length element is configured for easy coupling without adding additional radii or portions to the instrument. can do.

[0027] According to embodiments, each of the fingers comprises a collar and / or an opening to which the elongated element is secured. The collar can be, for example, a body connected radially inwardly with a channel for accepting and fixing the elongated element and / or the connecting member of the elongated element. The opening can be an opening of any shape (eg, a hole, a keyhole) in the finger that can accept and secure the elongated element and / or the connecting member of the elongated element. This ensures that the length elements are secured to the fingers for proper configuration and easily coupled to the steering device and that they are not discoupled before or during use. The length elements are coupled so that they can move longitudinally during the use of the instrument. In some embodiments, the length element can be tensioned by a collar or a connection to an opening. This can further ensure that the length elements are properly positioned and ready for use when needed. Tensioning can be by frictional connections, or by joining or mechanical attachment or connection. If by joining or mechanical mounting, this mounting can be configured to break upon connection and / or use to the steering device, which is why it is long for proper steering. Facilitates longitudinal movement of elements.

[0028] According to embodiments, the plurality of fingers of the support extend outward from the longitudinal axis from a storage position where the fingers extend near the longitudinal axis of the long instrument. Can move to the position of use. Such configurations can allow smaller coverings for transport and storage, while allowing easy movement to use configurations. The ability to move the finger closer to the longitudinal axis can also allow the use of less packaging material due to the overall smaller volume.

[0029] According to an embodiment, the finger can be urged outward to the position of use when stationary, and the support and device are joined as soon as the packaging or other material is removed. Guarantee that you are ready to do.

[0030] According to embodiments, the support and / or length device comprises a joint for coupling to the steering device. It can be within the shaft and / or the elongated element, for example, the joint on the end and / or part of the finger of the elongated element can be secured to a portion of the steering device. In some embodiments, the length element and / or the finger is connected to the steering plate and the shaft is also connected to the steering device. The steering device can then move the longitudinal element longitudinally with respect to the shaft, thereby controlling the movement of the distal end of the instrument.

[0031] According to embodiments, the length element is a flexible wire or cable. The support can ensure that the wire or cable is positioned for easy and proper coupling with the steering device, despite the flexibility of the individual wire or cable, so that the flexible wire or Especially useful with cables. Optionally, the support can even tension the wire or cable so that the wire or cable transmits the appropriate force for control of the distal end, or part of the device to which the wire or cable is secured. Helps to guarantee.

Further features and advantages of the invention will become apparent from the description of the invention in a non-limiting and non-exclusive embodiment. These embodiments should not be construed as limiting the scope of protection. Those skilled in the art will appreciate that other alternatives and equivalent embodiments of the invention can be conceived and practiced without departing from the scope of the invention. Moreover, the distinct features of the different embodiments are not explicitly shown in the drawings or described herein, unless such a combination is physically impossible. Can be combined. The scope of the invention is limited only by the claims and their technical equivalents.

[0033] The invention is discussed in more detail below with reference to the accompanying drawings, in which similar or same reference numerals indicate similar, same or corresponding portions.

[0034] An instrument having a steering device according to an embodiment of the present invention is shown. [0035] Fig. 1A shows an instrument with a steering device, the instrument being detached from the steering device. [0036] A perspective view of the end of the instrument and the locking plate of the steering device is shown. [0037] FIG. 2A shows a perspective view of the end of the instrument and the locking plate, the instrument being separated from the locking plate. [0038] FIG. 6 is a perspective view of an embodiment of an end of an instrument connected to a steering device. [0039] Shown is a set of appliances connected and having a steering device with a deflection at the distal end. [0040] FIG. 6 shows a perspective view of a rigid length element that has been extended for connection to a steering plate. [0041] Shown is an elongated element of rigidity that connects to different embodiments of the steering plate. The length elements of rigidity that connect to different embodiments of the steering plate are shown. The length elements of rigidity that connect to different embodiments of the steering plate are shown. [0042] Shows a rigid length element that is connected and locked to various embodiments of a locking mechanism for a steering device. It connects to various embodiments of a locking mechanism for a steering device and shows a rigid length element that is locked. It connects to various embodiments of a locking mechanism for a steering device and shows a rigid length element that is locked. It connects to various embodiments of a locking mechanism for a steering device and shows a rigid length element that is locked. It connects to various embodiments of a locking mechanism for a steering device and shows a rigid length element that is locked. [0043] An embodiment of a steering device in which an instrument is coupled to the steering device is shown. An embodiment of a steering device in which an instrument is coupled to the steering device is shown. [0044] A cross-sectional view of the joint shown in FIGS. 10A to 10B is shown. The cross-sectional view of the joint part shown in FIGS. 10A to 10B is shown. [0045] The perspective view of the embodiment of the support portion connected to the end portion of the instrument is shown. [0046] FIG. 6 shows a perspective view of a second embodiment of a support portion connected to an end of an instrument. [0047] A perspective view of a third embodiment of the support portion is shown.

[0048] Similar reference numbers will be used in different figures to indicate similar elements.

FIG. 1A shows a non-limiting embodiment of an instrument 100 having a steering device 102 according to an embodiment of the present invention. FIG. 1B shows the appliance 100 detached from the steering device 102. FIG. 2A shows an enlarged perspective view of the end of the equipment 100 fixed together and the locking plate 116 of the steering device 102, and FIG. 2B shows a perspective view of the end of the separated equipment 100 and the locking plate 116.

[0050] Instrument 100 is shown schematically to represent any steerable instrument for use in medical or other surgery. Suitable instrument configurations can be found in NL2021823, entitled "Steerable instrument comprising a tube element", filed October 16, 2018 and incorporated herein by reference. The instrument 100 includes a long shaft 106 and a plurality of long elements 108 arranged around a central axis 109. The elongated element 108 shown is a flexible cable or wire that extends along the instrument shaft 106, connects to the steering plate 110 at the proximal end of the instrument, and is distally deflectable at the distal end of the instrument. Connect to a section (not shown). Alternatively, such length elements are mounted by longitudinal strip-shaped elements within the tube element, as described in detail in, for example, WO2009 / 112060A1, WO2009 / 127236A1, WO2017 / 213491A1, and WO2018 / 067004. And can be separated by a longitudinal slot resulting from laser cutting a given pattern in a cylindrical tube, or by a rigid cable or wire.

The steerable instrument is placed at the proximal end when manually operated to steer the distal end of the device and / or to operate a tool placed at the distal end of the device. Can include handles (see FIGS. 10A-10D). Such a tool can be, for example, a camera, a manual manipulator, such as a pair of scissors, a manipulator that uses an energy source, such as an electrical, ultrasonic, or optical energy source. The instrument has no restrictions on the type of tool applied to the distal end. The type of handle or robot steering unit and / or connection will be selected depending on the type of tool applied at the distal end, intended use, and other equipment or operating requirements.

[0052] The steering plate 110 of the appliance 100 is movably connected to the support member 111, which is shown as a ball shape in this embodiment, but can have different shapes in different embodiments. In some embodiments, the steering plate 110 may be connected differently (eg, directly to the channel or locking plate) and / or may not include a support member 111. The support member 111 is tightly connected around the shaft 106 at the proximal end of the shaft 106. The steering plate 110 can be deflected (but does not rotate) around the support member 111. This can be done, for example, by using the pins and recesses in the support member 111 and the steering plate 110, respectively. Such movement allows the steering plate 110 to move for steering movement, but may result in loss of steering capability and reduced control of deflection at the distal end of the instrument 100. Prevents complete rotation that can result in winding up.

[0053] Each length element 108 is connected through an opening 112 in the steering plate 110 and is one of a variety of different methods, such as crimping, bending the ends of the element, rather than the opening. Secure to the steering plate 110 by attaching a large ball or other device to the end of the element, etc. The elongated element 108 connects to different parts of the steering plate 110 in a circumferential direction, typically around the steering plate 110. The connection of the elongated element 108 to the steering plate 110 is shown open, but in the instrument used, the element 108 and, in some cases, the steering plate 110 are likely to be covered, for example, by a sleeve. Let's go. Fixation of the elongated element 108 to the steering plate 110 is typically done at the time of manufacture, so that the instrument 100 can be shipped to a location ready for use by a simple coupling to the steering device 102. .. Different instruments can include different numbers of length elements 108 depending on the desired deflection capacity.

[0054] The steering plate 110 is connected to three axially extending protrusions 114 for connecting the instrument 100 to the locking plate 116 of the steering device 102. Different embodiments may have more or less connection points and / or may include different releasable coupling configurations for connecting the instrument 100 with the steering plate 110 to the steering device 102.

[0055] The steering device 102 includes a locking plate 116 with a first plate 118 with an opening 120 and a second plate 122 with a fixing slot 123 (see FIG. 2A), for example forming a bayonet fitting. do. The first plate 118 has a closed position in which the second plate 122 is aligned with the opening 120 from the open position where the wider portion of the fixed slot 123 is aligned with the opening 120. It is rotatably connected to the second plate 122, as is possible (see FIG. 2A). In the closed position, the protrusion 114 is fixed to the opening 120, whereby the steering plate 110 is fixed to the locking plate 116 and moves with the locking plate 116.

[0056] The locking plate 116 is connected to the steering unit 102. A simple version of the steering unit 102 and the connection is illustrated in FIGS. 1A-1B, where the locking plate 116 is connected to the actuator 124 about a hinge shaft 126. Other embodiments may include another frame with a different hinge axis to allow arbitrary movement of the steering plate 110 (and locking plate 116) in space (eg, FIGS. 3A-3B). See). The steering unit 102 can be controlled manually, through a robot, or a combination of the two.

[0057] As illustrated in FIGS. 1A and 2A, the instrument 100 connects to the steering device 102 through a steering plate 110 that connects to the locking plate 116 by fixing the protrusion 114 into the opening 120. The second plate 122 is rotated so that the protrusion is fixed by the slot 123 and cannot return through the opening 120.

The instrument 100 can then be controlled by a steering device using the actuator 124 to move the locking plate 116. When the steering plate 110 is fixed to the locking plate 116, the steering plate 110 moves around the support member 111 as the locking plate 116 moves, causing tension in some elements 108 and in other elements 108. Causes relaxation. This will cause an angular deflection of the instrument shaft 106 from the axis 109 at the distal end of the instrument 100 to which the element 108 is also connected (as shown in FIG. 3B). In some embodiments, the element 108 can be connected at a point (not just the distal end) along the shaft 106 of the instrument 100 and is bent or bent onto a portion of the instrument shaft 106 to which the element 108 is connected. Causes deflection. Any number of deflection or flexion zones can be included by using an appropriate number of length elements 108 and connecting them at appropriate positions along the overall length of the instrument 100. In addition, the amount of angular deflection can be reduced from the proximal end to the distal end, with elements at the proximal end at points of greater radial distance centered on the longitudinal axis than at the distal end. Can be connected at. This results in the conversion of larger movements at the proximal end to smaller deflections at the distal end, ensuring precise and accurate movement of the tool at the distal end. In some embodiments, the instrument can be configured in the opposite form in which movement from the proximal end is amplified at the distal end.

[0059] Upon completion of the surgery or procedure, the instrument 100 can be easily and quickly detached from the steering device 102. This is done by rotating the second plate 122 to the open position and moving the instrument 100, thereby moving the steering plate 110 and the protrusion 114 axially away from the steering unit 102 and out of the opening 120. The instrument 100 can then be discarded and the steering device 102 is available for use with the new clean instrument 100 for further surgery. In some embodiments, the device 100 can be sent for cleaning and hygiene in preparation for reuse. In such embodiments, the ability to separate parts that require cleaning can help ensure that proper cleaning and sterility can be performed. For example, a detached instrument can be placed in a sanitized chamber, whereas an unseparated instrument may not be due to size and / or other sensitive parts.

[0060] As discussed in the background art, reused past instruments required extensive cleaning and decontamination work for safe reuse. This was a time consuming process that did not necessarily remove all contaminants. While some steerable instruments were disposable to avoid the time, cost, and risk of attempting cleaning, disposing of the complete instrument after each surgery is very costly. Only a portion of the contaminated appliance is discarded (or cleaned in some situations) by using the steering device 102, which can be quickly, easily and reliably coupled to and separated from the appliance 100. And can be sterilized) and the other parts can be safely reused without the need for extensive decontamination processes. Since the steering part of such an instrument can be a complex and relatively expensive part, it is possible to separate the exposed part of the instrument from the steering part and it is of great economic benefit to dispose of only the exposed part. Yes and bring less waste. Using a quick and simple coupling between the steering plate 110 and the locking plate 116 of the steering device 102 is a disposable device to the reusable steering device 102 by a non-trained or non-technical person at the place of use. Allows 100 rapid binding and separation.

[0061] FIG. 3A shows a perspective view of a second embodiment of the end of the appliance 100 connected to the steering device 102, including a schematic view of the robot control device 129, FIG. 3B is connected and distal. Shown is a set of instruments 100 having a steering device 102 with edge deflection. The instrument 100 is coupled to the steering device 102 as shown in FIGS. 1A-2B, and the steering plate 110 is coupled to the locking plate of the steering device 102 (not shown in FIGS. 3A-3B).

[0062] The steering device 102 includes an inner frame 130 connected to the outer frame 131 at the shaft 134 so that the inner frame 130 can rotate within the outer frame 131 about a hinge shaft 134. The rotation about the axis 134 is controlled by the actuator 124. The outer frame 131 is connected to the steering device 102 at the hinge shaft 132 (such connections are not shown in FIGS. 3A and 3B). The rotation about the shaft 132 is also controlled by the actuator 124. Such a suspension around the two hinge axes 132 and 134 allows the steering plate 110 to move at any angular position in space. The steering plate 110 is also circumferentially coupled to the inner frame 130 using ball bearing suspensions so that the steering plate 110 and thus the instrument 100 can rotate within the inner frame 130. This rotary suspension can be a rotary bearing between the steering plate 110 and the inner frame 130, but can be done in other forms in different embodiments. Rotation rotates the entire instrument, including the steering plate 110 (and thus the rotating element 108) and the instrument shaft 106. In general, the shaft 106 (or another tube of the instrument 100) is configured to ensure that the instrument stays in the desired deflection position, so that the rotation is along the longitudinal axis and the deflected tip. Guarantee that it does not result in orbital rotation. This ensures that the cable 108 does not twist from the rotational movement, and the tip can rotate while maintaining its spatial orientation.

[0063] FIG. 3B shows an example of a deflection of the steering plate 110 that causes a deflection at the distal end of the instrument 100. Actuator 124 moves the inner frame 130 so that it is deflected in a particular direction. This causes tension in some wires and relaxation in others, thereby causing deflection at the distal end. For different deflections, the steering mechanism 102 can cause the frame 131 to rotate about the axis 132. The instrument 100 can also be rotated in this bent position by rotating the steering plate 110 with respect to the inner frame 130. This rotation is transmitted to the distal end through the rotation of the shaft, inner tube and / or outer tube along the instrument 100. The distal end of instrument 100 (with possible tools) is then rotated. Some embodiments have wires connected differently (eg, rotated 180 °) at the distal end so as to cause the opposite deflection of the distal end for the same movement illustrated in the steering unit 102. Can include. As discussed above in relation to FIGS. 1A-1B, the deflection movement can be increased or decreased.

[0064] As seen in FIGS. 3A-3B, the steering device 102 is provided to allow movement and rotational movement of the steering plate 110 in any three-dimensional plane, and thus arbitrary bending or rotation of the instrument 100. Suspension and control through can be complicated. Reusing the steering device 102 while allowing the disposable instrument 100 by using the steering plate 110 to which the long element 108 of the instrument is secured and providing a quick but simple and secure connection to the locking plate 116. can do. This allows for a more complex steering device 102 and is particularly useful in robotic applications.

[0065] FIGS. 1A-3B show an instrument using flexible wires or cables for the length element 108 for instrument steering. Such an instrument requires a connection of the length element 108 to the steering plate 110, which is connected to the shaft 106 (through the support member 111) or another fixed connection at the proximal end and is length. It ensures that the element 108 is held in tension and allows proper steering movement when connected to the steering device 102. Such tensioning can be done at the time of manufacture and / or partially through the joints used for coupling to the steering device 102 (see, eg, FIGS. 10A-10D). The movement of the steering device 102 that moves the steering plate 110 results in the movement of the instrument, especially the flexion at the distal tip. The frames 130, 131 are then aligned as shown in FIG. 3A, the elongated element 108 is in a stationary position, and the instrument is generally its longitudinal axis (or any stationary position in which the instrument is configured). It extends linearly along. When the steering device 102 causes the movement of one of the frames, for example, when bent about the shaft 132, the length element on one side of the shaft 132 is pulled under tension and the length on the other side. The shaku element moves to the relaxed position. This results in a flexion of the distal tip in 3D space, as the long tensioned element pulls the distal apex of the instrument 100 in that direction and the relaxed element allows the flexion movement. .. Of course, more complex flexion and / or rotational movements can be performed through the use of frames and rotating shafts, especially when the robot steering device 129 is used to control precise movements.

[0066] FIGS. 4-10D show alternative embodiments in which longitudinally rigid cables, wires, or other elongated elements can be used (the figure shows elongated strips only as a schematic diagram. ). Instruments using such rigid cables or wires 108 are additional in that the element 108 can be pushed or pulled by the steering plate 110 due to the precise deflection of the distal tip of the instrument 100. Will have the ability to deflect. In addition, the longitudinal stiffness of the rigid cable or wire eliminates the need for the steering plate 110 to connect to the shaft 106, as the rigid elongate element does not need to be tensioned on the steering plate 110. Therefore, they can be directly connected to the steering / locking plate, as shown in the following embodiments.

[0067] FIG. 4 is an example of an extended rigid length element 408 for connecting to a steering plate that is part of a steering unit (instead of some of the disposable appliances as seen in FIGS. 1A-3). Is shown. The elongated element 408 is arranged by the conical device 402 so as to extend outward from the central axis 409 of the instrument, and the conical device 402 is such that the elongated element 408 is extended by the outer surface of the conical device 402. It is arranged so as to surround the shaft 406 so as to be.

[0068] Any other suitable device or method may be used to properly position the elongated element at the proximal end so that the elongated element extends outward from the central axis of the instrument. It should be understood that it can be done.

[0069] FIG. 5 shows a steering device 500 according to an embodiment to which an instrument is connected.

[0070] The steering device 500 includes a support member 502 and a steering member 504. The support member 502 comprises a ball-shaped element traversed by the first channel 508, the first channel 508 having a circular shape, from the proximal end 510 of the steering device 500 to the distal end of the steering device 500. It extends to 512. The first channel 508 extends from the ball-shaped element 506 at the proximal end of the steering device 500, thereby defining a hollow tube 514 extending outward from the ball-shaped element.

[0071] The steering member 504 includes a steering plate 516 and a second channel 518 located at the center of the steering plate 516, the second channel 518 having a circular shape. The support member 502 allows the steering member 504 to move around the ball-shaped element 506 (although it does not rotate about the central axis 530, as described in connection with FIGS. 1A-2B), and the first. The central axis 520 of the channel 508 of the second channel 518 is arranged in the second channel so as to coincide with the central axis 530 of the second channel 518.

[0072] The steering plate 516 comprises a plurality of grooves 532 extending inward from the circumference of the steering plate 516, the groove 532 having a U-shape, but in different embodiments taking several different shapes. be able to.

[0073] The steering device 500 is configured to be attached to the appliance by the following method. Each length element 408 includes a connecting portion 509 that can be fitted into the groove 532 and secured within the groove 532. In this case, the T-shaped connection has a narrower portion to enter the groove and a wider portion at the end to ensure that longitudinal movement of the elongated element is not allowed when connected. Formed by. The instrument inner shaft 406 is steered so that the instrument center axis 409 coincides with the center axis 520 of the first channel 508 and the connection portion 509 of the elongated element 408 aligns with the groove 532. It is introduced into the side surface of the first channel 508 of the support member 502 located at the distal end of the. The connection portion 509 of the elongated element 408 is then pushed into the groove 532 so that the wider upper portion of the T-shape is secured proximal to the steering plate, as shown in FIG.

[0074] Once the length element 408 is secured to the steering plate 516, the movement of the steering plate 516 around the support element 506 pushes or pulls on the length element 408, thereby causing a distal deflection (FIG. FIG. As seen in 3B).

[0075] FIG. 7 shows an alternative embodiment of the steering device 500 of FIG. 5, in which the steering plate 516 comprises a plurality of openings 702 in place of the circumferential groove. The method of attaching the instrument to the steering device 700 is similar to that described with reference to FIG. 5, but in this embodiment the connecting portion 509 of the elongated element is "clicked" within the receiving portion of the steering plate 516. It is pressed against the opening so that it "enters". As seen in this embodiment, the connection snaps into a complementary shaped receiving portion within the steering plate 516, which is a twist of the characteristic catcher (here, the T-shaped connection 509). It has an inclined portion and a central opening for guiding a wide "top") to a fixed position.

[0076] FIGS. 8A and 8B show embodiments of FIG. 6 further comprising a locking mechanism in the form of a locking plate 804. The locking mechanism 802 shown in FIGS. 8A and 8B is movable between an open position (shown in FIG. 8A) and a closed position (shown in FIG. 8B).

[0077] As seen in FIG. 8A, the steering device 500 and the appliance are coupled to each other such that the elongated element 408 is disposed within the groove 532, as described with reference to FIG. FIG. 8A shows a locking mechanism 802 for fixing the long element 408 to the steering member 504, in which the locking mechanism 802 is open so that the long element 408 can be inserted into or removed from the groove 532. It is in. The locking mechanism 802 includes a locking plate 804 having a circular shape with an opening in the center so that the tube 514 of the support member 502 can pass through the opening. The locking plate 804 is axially movable from an open position where the elongated element 408 is inserted into or removed from the groove 532 to a locking position where the elongated element is secured within the opening, eg, locking. The plate 804 can move toward or away from the steering device 500 along the central axis 806 and / or can move in a rotating manner.

[0078] FIG. 8B shows an embodiment of FIG. 8A in which the locking mechanism is moved from the open position shown in FIG. 8A to the locked position of FIG. 8B by moving the locking plate axially towards the instrument. This movement is until the locking plate 804 clicks into the connection portion 509 of the steering plate 516 and / or the elongated element 408, thereby preventing the elongated element 408 from being removed from the groove 532 or the opening 702. .. The locking mechanism and / or plate 804 can have several different shapes as long as it can be quickly and reliably coupled to the steering plate 516 to ensure that the elongated element 408 is secured to the steering plate 516. , And / or can be connected in several different ways. The connection must also be such that it can be quickly and easily disconnected when the operation is complete.

[0079] FIGS. 9A, 9B, and 9C show alternative structures for the locking mechanism of FIG. The locking mechanism 1000 shown in FIGS. 9A, 9B, and 9C includes a locking plate 1002. The locking plate 1002 comprises an opening arranged so that the locking plate 1002 can be rotatably mounted with respect to the steering plate 516. The locking plate 1002 comprises a plurality of projecting elements 1004 extending around the outer circumference of the locking plate. Each of the projecting elements 1004 comprises a hook-shaped side surface 1006 forming the channel 1010 and an inclined side surface 1008.

[0080] In FIG. 9A, each elongated element 408 is an inclined side surface of the projecting element 1004 adjacent to the hook-shaped side surface 1006 of the projecting element 1004 so that the elongated element 408 can be removed from the groove 532 of the steering plate 516. The locking mechanism 1000 located between 1008 and 1008 is shown.

[0081] The locking plate 1002 is configured to rotate clockwise from the open position shown in FIG. 9A to the locked position shown in FIG. 9B. The locking plate 1002 shown in FIG. 9A moves towards the corresponding long element 408 with each hook-shaped side of the protruding element 1004 until the long element is inside the channel 1010 defined by the hook-shaped side. As shown in FIG. 9B, the elongated element 408 is anchored in the channel 1010.

[0082] FIG. 9C shows the locking device shown in FIG. 9B after being rotated counterclockwise from the locked position to the removed position where the elongated element 408 was removed from the groove. By rotating the locking plate 1002 counterclockwise, each tilted side surface 1008 of the overhanging element 1004 moves towards the corresponding elongated element 408, so that the elongated element slides over the tilted side surface 1008. , Extruded from its corresponding groove 532 by the inclined side surface 1008, thereby reaching the removal position shown in FIG. 9C where the elongated element 408 disengages from the groove 532.

[0083] FIGS. 10A-10D show another embodiment comprising instrument 1100, steering device 1101, and locking mechanism 1103. 10A and 10B show the fixture and steering device coupled together, the locking mechanism is in the open position in FIG. 10A and in the closed position in FIG. 10B. 10C and 10D show cross-sectional views of the fixture 1100 and steering device coupled together.

[0084] FIGS. 10A-10D show an instrument 1100, such as the instrument of FIGS. 1A-1C, where the connecting portion 1104 of the elongated element 1102 has a circular shape instead of the different shape shown in other embodiments.

[0085] The locking mechanism 1103 shown in FIGS. 10A-10D has a hemispherical shape having a locking portion that operates in the same manner as the locking plates 1002 shown in FIGS. 9A-9C. The locking mechanism 1103 includes a slot for receiving the connection portion 1104 of the elongated element 1102. The elongated element 1102 can be slid into place by following the curvature of the conical section 1106 leading to the receiving groove 1108. As seen in FIG. 10C, the conical section 1106 is moved closer to the locking mechanism 1103 when in the open position. This allows for easier insertion into the groove 1108 (and removal of elongated elements). When the elongated element 1102 is arranged in the groove, the locking mechanism 1103 rotates to fix the elongated element in a predetermined position in the groove. This is shown in FIGS. 10A and 10D. Such rotational movement to the locking position also extends the conical section 1106 axially with respect to the locking mechanism 1103 (see FIG. 10D). This ensures proper tensioning of the length element 1102 and guarantees proper bending and deflection of the instrument. The instrument is easily removed by rotating the locking mechanism 1103 to bring the conical portion 1106 closer to the steering device 1101, pushing the elongated element 1102 out of the groove 1108, and then pulling the instrument axially away from the steering device 1101. be able to. As seen in FIG. 11B, when the locking mechanism 1103 is rotated to the open position, the elongated element 1102 is pushed out of the groove 1108 for easy removal of the instrument from the steering device. Rotation can be done manually or automated, for example through the use of grip portion 1110.

[0086] FIGS. 11-13 are supports that can be used to allow connection of long elements to a steering mechanism (similar to the steering mechanism connection illustrated in any of FIGS. 4-10D). An embodiment of a part and a support configuration is shown. Each of the indicated supports can be made of metal or plastic material and, in some embodiments (eg, FIG. 13), can be formed as part of the instrument 100 itself.

FIG. 11 shows a support portion 1120 having a base portion 1122 and a finger portion 1124 that is tightly connected to the base portion 1122 and extends outward from a central longitudinal axis 409 extending along the instrument and support portion 1120. .. The base 1122 is secured around the outside of the shaft 106 of the instrument 100 so that the base 1122 and thus the support 1120 cannot move or shift longitudinally with respect to the instrument shaft 106. The base 1122 can be secured by tight coupling, welding, joining, glue, threads, threads, spring elements, or any other means that will secure the base 1122 to the shaft 106.

[0088] Each arm 1124 includes a collar portion 1126 to which the elongated element 1102 is fixed. In the embodiment shown in FIG. 11, each collar portion comprises a cylinder fixed around the longitudinal element 1102 to hold the element 1102 in the correct radial position / orientation and in tension. The element 1102 can move longitudinally with respect to the collar portion 1126 to facilitate steering. Each element 1102 has a connection 509 at the end of each element 1102 in the form of a sphere or other mechanical feature (eg, cylinder, hook, hole). The entire sphere and / or support can facilitate connection to a steering device, which may include a steering plate, as described and shown in connection with the previous figure. Longitudinal tension can be maintained by the frictional force between the elongated elements 1102 and the connection to the support 1120. In other embodiments, joints or mechanical attachments or connections can be used to maintain longitudinal tension in the elongated element 1102. The attachment can be configured to break after being coupled to the steering device. This may be due to either steering activation or a mechanism within the steering device that breaks the connection within the steering device. For example, a small amount of adhesive can be inserted in the connection of the element 1102 to the collar portion 1126. It can be physically located where a portion of the steering device will break the adhesive connection and / or tension application from the connection to the steering device will break the adhesive connection.

FIG. 12 shows a perspective view of a second embodiment of the support 1220 connected to the end of the instrument. The support portion 1220 is similar to the support portion 1120 and connects to the elongated element 1102 in a similar manner, but the base portion 1222 is formed as part of the shaft 106 of the appliance 100.

[0090] The instrument shown in FIG. 12 is formed from one or more cylindrical tubes that extend along the shaft 106 and form at least a portion thereof. The one or more tubes forming the shaft 106 typically extend from the proximal end (shown) to the distal end (see FIG. 3B) connecting to the steering device. The distal end typically has some instrument (eg, scissors, grippers), but does not need to have an instrument.

[0091] The support portion 1220 is formed from an outer tube 1222 that is divided into finger portions 1224 at the proximal end. The finger portion 1224 cuts the tube 1222 longitudinally at various points around the circumference from the proximal end over a particular length, such as 5-100 mm, preferably 10-50 mm, more preferably 15-30 mm. Can be formed by The finger portion 1224 is then shown to keep the length element 1102 under tension and in place to connect to the steering plate and / or steering device (not shown in FIG. 12). Can be positioned or bent outwards. This bending can be performed using a device as shown in FIG. 4 or another device or method. Cutting can be done, for example, by laser cutting.

[0092] FIG. 13 shows a perspective view of a third embodiment of a support portion 1320 similarly formed from a longitudinal outer tube 1322 that is cut longitudinally to form a finger portion 1324. The finger portion 1324 includes an opening 1326 to which the elongated element 1102 can be connected. The elongated element 1102 in the form of a flexible cable connects to the opening 1326 through a hook connection that secures the cable to the finger portion 1324. Other suitable connections can include connections through other elements, laser welding, brazing and / or joining. In this embodiment, the finger portion 1324 then includes a connecting portion 1328 that can be connected to a steering plate and / or a steering device. Longitudinal cuts in tube 1322 can extend only part of the instrument or over its entire length and, in some embodiments, can be used to transmit steering or bending forces from the proximal end to the distal end. can.

The fingers of the support shown in FIGS. 11-13 can be made with the configuration shown, and when the instrument is packed, the fingers fold to a smaller radius substantially parallel to the longitudinal axis. Or bent. When unpacked and ready to be coupled to the steering device, the fingers can be manually unfolded or configured to simply bounce back into position for coupling (ie, they are. , When stationary, tension is applied as shown in FIGS. 11-13). The ability to move the finger from the storage position to the use position makes it possible to require less space and less packaging material for storage and / or transportation due to the overall smaller volume. The use of a support with fingers provides an easy way to support and tension the long element 1102 of the instrument for easy coupling and then to use with the steering device. The use of supports can thus eliminate the need for disposable parts of the instrument to include a steering plate.

[0094] In summary, having an instrument that can be easily connected to and disconnected from the steering device enables an effective instrument that is more economical. The ability to connect and disconnect instruments quickly and easily allows the use of disposable instruments, while the more complex and expensive parts can be reused. A reliable but simple coupling ensures that even a non-technical person can prepare a set of devices for operation or disconnect when the operation is complete. The use of steering plates to connect to steering devices ensures that even long instruments with flexible wires or cables are ready for use and move with precise control when coupled to steering devices. Guarantee.

[0095] The examples and embodiments described herein serve to illustrate, but do not limit, the invention. Elements from different embodiments can be combined to form embodiments not shown in the figure, unless such combinations are incompatible. Those skilled in the art will be able to design alternative embodiments without departing from the claims. Reference numerals placed in parentheses in the claims should not be construed to limit the scope of the claims. Items described as separate entities in the claims or description may be implemented as a single item or multiple hardware items that combine the features of the items described.

[0096] The term robotics is used to describe possible embodiments of steering devices. The term is commonly used to refer to a programmable machine capable of autonomously or semi-autonomously performing a series of operations, including one or more computers, processors, memory, control units, and the like. It can contain several components, not limited to. The sequence of movements can include movements for the instrument, including bending, rotation, etc., and the use of the robot allows, in some cases, more precise movements than manual control can generally achieve. Can be.

[0097] It should be understood that the invention is limited only by the appended claims and their technical equivalents. In this document and its claims, the verb "to comprise" and its conjugations mean that the item following that term is included without excluding items that are not specifically mentioned. As such, it is used in their non-restrictive sense. In addition, references to elements by the indefinite article "a" or "an" have more than one element unless the context explicitly requires that there be only one and one element. Do not rule out the possibility. The indefinite article "a" or "an", for this reason, usually means "at least one".

Claims (31)

A steering device for connecting to a long instrument extending along an instrument shaft and having a plurality of elongated elements secured to a steering plate at the proximal end of the instrument shaft, wherein the steering plate is said to be said. Movably connected around a support member secured to the instrument shaft, the steering device is
The locking plate and the locking plate having a joint capable of fixing the steering plate so that the steering plate and the locking plate move together.
-A steering device including a steering unit for moving the locking plate. The locking plate is a first plate having one or more openings for receiving one or more protrusions from the steering plate and the one or more protrusions in the one or more openings. The steering device according to claim 1, further comprising a second plate capable of fixing the steering device. The second plate has the steering plate secured to the locking plate from an open position to allow movement into or out of the one or more openings of the one or more protrusions. The steering device according to claim 2, wherein the one or more protrusions rotate from the one or more openings to a locked position where they cannot move. One of claims 1 to 3, wherein the steering unit comprises one or more frames connected about one or more axes to allow movement of the steering plate in space. The steering device according to one item. The steering device according to any one of claims 1 to 4, wherein the locking plate is connected to the steering unit so that the locking plate can rotate with respect to the steering unit. The steering device according to claim 5, wherein the locking plate is connected to the steering unit by using a circumferential ball bearing. The steering device according to any one of claims 1 to 6, wherein the steering device includes a robot unit. The long element is any one of claims 1 to 7, wherein the long element is a flexible cable or wire extending through the long device to move the distal end of the long device. The steering device described. A long device for connecting to a steering device, and the long device is
A long shaft with a distal end and a proximal end,
A steering plate located at the proximal end of the elongated shaft, wherein the steering plate is movably arranged around a central support member connected around the elongated shaft. The steering plate is provided with a coupling portion for coupling the steering plate to the steering device in order to control the movement of the steering plate.
A long instrument comprising a plurality of long elements extending along the long shaft and secured to the steering plate at the proximal end. The long device according to claim 9, wherein the plurality of long elements are fixed in a circumferential direction around the steering plate. The elongated device of claim 9 or 10, wherein the joint comprises one or more elements for openly connecting to the locking plate of the steering device. 11. The elongated instrument of claim 11, wherein the one or more elements include one or more extensions that can be openly secured to the locking plate of the steering device. 9. The central support member comprises a ball-shaped element, wherein the steering plate is connected to the ball-shaped element so that the steering plate can rotate around the ball-shaped element. The long instrument according to any one of 12 to 12. The plurality of length elements extend through a plurality of openings in the steering plate, and each length element has a fastener at the proximal end to secure the length element to the steering plate. The long instrument according to any one of claims 9 to 13. The long instrument according to any one of claims 9 to 14, wherein the plurality of elongated elements include a plurality of flexible wires or cables. The plurality of flexible wires or cables according to any one of claims 9 to 15, wherein tension is applied between a position along the long shaft and a position along the steering plate. Long instrument. A method of manufacturing a steerable device that can be coupled to a steering unit, wherein the method is
Forming an instrument with a long shaft and a steerable part,
To movably connect the steering plate around the long shaft at the proximal end, where the steering plate is to connect the steering plate to the steering device in order to control the movement of the steering plate. It has a joint part of
A method comprising connecting a plurality of long instruments to the steerable portion and the steering plate. The step of movably connecting the steering plate around the elongated shaft at the proximal end comprises movably connecting the steering plate around a ball-shaped support member fixed to the elongated shaft. The method according to claim 17. The step of connecting a plurality of long elements to the steerable part and the steering plate is
A plurality of long elements are connected to a support portion including a plurality of fingers, and here, each of the plurality of long elements is connected to one of the plurality of fingers.
17. The method of claim 17, wherein the plurality of elongated elements are connected to the steerable portion and the steering plate at the support portion. A long device for connecting to a steering device, and the long device is
A long shaft with a distal end and a proximal end,
A support at the proximal end of the elongated shaft, where the support comprises a base and a plurality of fingers extending outwardly in the circumferential direction from the longitudinal axis.
A long instrument comprising a plurality of long elements extending along the long shaft and secured to the support at the proximal end. 20. The long instrument of claim 20, wherein the base is connected around the shaft. 20. The long instrument of claim 20, wherein the base comprises a long outer tube and the fingers are formed by cutting the long outer tube into a plurality of longitudinal sections. The cut passes through the long outer tube so that the long outer tube can at least partially transmit a bending force from the proximal end of the long instrument to the distal end of the long device. 22. The long device according to claim 22. The long instrument according to any one of claims 20 to 23, wherein each of the fingers has a collar and / or an opening to which a long element is fixed. 24. The long instrument of claim 24, wherein the collar fixes and tensions the long element. The plurality of fingers of the support portion have the fingers outward from the longitudinal axis from a storage position in which the fingers extend substantially parallel to the longitudinal axis of the long instrument. The long instrument according to any one of claims 20 to 25, which can be moved to an extended use position. 26. The long instrument according to claim 26, wherein the plurality of fingers are urged outward with respect to the position of use when the fingers are stationary. The long device according to any one of claims 20 to 27, wherein the support portion and / or the long device includes a joint portion for connecting to a steering device. The long instrument according to any one of claims 20 to 28, wherein the plurality of elongated elements include a plurality of flexible wires or cables. 29. The elongated instrument of claim 29, wherein the plurality of flexible wires or cables are tensioned between a position along the elongated shaft and a position along the support. 30. The connection between the flexible wire or cable and the support comprises a mechanical or joined connection configured to be broken for the use of the length device. Long instrument.

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